San Antonio Medicine August 2015

MEDICINE SAN ANTONIO

THE OFFICIAL PUBLICATION OF THE BEXAR COUNT Y MEDICAL SOCIET Y

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AUGUST 2015

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VOLUME 68 NO. 8

Serving Special-needs Children

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MEDICINE SAN ANTONIO

THE OFFICIAL PUBLICATION OF THE BEXAR COUNTY MEDICAL SOCIETY

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WWW.BCMS.ORG

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Serving Special-needs Children

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AUGUST 2015

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VOLUME 68 NO. 8

San Antonio Medicine is the official publication of Bexar County Medical Society (BCMS).

All expressions of opinions and statements of supposed facts are published on the authority of the writer, and cannot be regarded as expressing the views of BCMS. Advertisements do not imply sponsorship of or endorsement

by BCMS.

The healing power of Morgan’s Wonderland

EDITORIAL CORRESPONDENCE: Bexar County Medical Society 6243 West IH-10, Suite 600 San Antonio, TX 78201-2092 Email: editor@bcms.org

Special to San Antonio Medicine ..............................14 BCMS President’s Message ..............................................8 BCMS Alliance..................................................................10

MAGAZINE ADDRESS CHANGES: Call (210) 301-4391 or Email: membership@bcms.org

BCMS News ....................................................................12

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Care System Profile: Children’s Rehabilitation Institute of Teleton USA by Ellie Leeper ......................................18 Business of Medicine: Is your bonus ‘reasonable’

COVER: Photo of Morgan's Wonderland

by Robin Jerstad

compensation? by Pamela C. Smith, PhD ....................21

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Business of Medicine: Trust: What successful people know by Jill Koob ....................................22

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Nonprofit: Any Baby Can special to San Antonio Medicine ........................................................24

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Lifestyle: 2015-16 arts season to offer dynamic performances by Julie Catalano ......................26 UTHSCSA Dean’s Message by Francisco González-Scarano, MD ........................................................28 Book Review: ‘I am Malala: The Girl Who Stood Up for Education and Was Shot by the Taliban’ Written by Malala Yousafzai with Christina Lamb, reviewed by Rajam Ramamurthy, MD ..................32 BCMS Circle of Friends Services Directory ............................................................................................33 In the Driver’s Seat ..................................................................................................................................39 Auto Review: Porsche Macan by Steve Schutz, MD ..............................................................................40

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San Antonio Medicine is published by SmithPrint, Inc. (Publisher) on behalf of the Bexar County Medical Society (BCMS). Reproduction in any manner in whole or part is prohibited without the express written consent of Bexar County Medical Society. Material contained herein does not necessarily reflect the opinion of BCMS or its staff.

San Antonio Medicine, the Publisher and BCMS reserves the right to edit all material for clarity and space and assumes no responsibility for accuracy, errors or omissions. San Antonio Medicine does not knowingly accept false or misleading advertisements or editorial nor does the Publisher or BCMS assume responsibility should such advertising or editorial appear. Articles and photos are welcome and may be submitted to our office to be used subject to the discretion and review of the Publisher and BCMS. All real estate advertising is subject to the Federal Fair Housing Act of 1968, which makes it illegal to advertise “any preference limitation or discrimination based on race, color, religion, sex, handicap, familial status or national orgin, or an intention to make such preference limitation or discrimination.

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BOARD OF DIRECTORS

OFFICERS James L. Humphreys, MD, President Leah Hanselka Jacobson, MD, Vice President Maria M. Tiamson-Beato, MD, Treasurer Adam V. Ratner, MD, Secretary Jayesh B. Shah, MD, President-elect K. Ashok Kumar, MD, Immediate Past President

DIRECTORS Jorge Miguel Cavazos, MD, Member Josie Ann Cigarroa, MD, Member Kristi G. Clark, MD, Member John Robert Holcomb, MD, Member John Joseph Nava, MD, Member Carmen Perez, MD, Member Oscar Gilberto Ramirez, MD, Member Bernard T. Swift, Jr., DO, MPH, Member Miguel A. Vazquez, MD, Member Francisco Gonzalez-Scarano, MD, Medical School Representative Carlos Alberto Rosende, MD, Medical School Representative Carlayne E. Jackson, MD, Medical School Representative Bonnie Harriet Hartstein, MD, Military Representative Rebecca Christopherson, BCMS Alliance President Gerald Q. Greenfield Jr., MD, PA, Board of Censors Chair Donald L. Hilton Jr., MD, Board of Mediations Chair George F. "Rick" Evans Jr., General Counsel

CEO/EXECUTIVE DIRECTOR Stephen C. Fitzer

CHIEF OPERATING OFFICER Melody Newsom Susan A. Merkner, Director of Communications August Trevino, Development Director Brissa Vela, Membership Director

COMMUNICATIONS/ PUBLICATIONS COMMITTEE Fred H. Olin, MD, Chair Jay S. Ellis Jr., MD, Member Jeffrey J. Meffert, MD, Member Esmeralda Perez, Community Member Rajam S. Ramamurthy, MD, Member J.J. Waller Jr., MD, Member

6 San Antonio Medicine • August 2015

PRESIDENT’S MESSAGE

BCMS Capital Campaign, new building on target

By James L. Humphreys, MD 2015 BCMS President

This is a good time for an update about the new BCMS building. Construction is proceeding apace, and so far our contractors have done an excellent job of staying on time with the various phases of construction. There were a few days lost during the heavy rains in May and early June, but otherwise that is going well. We have been staying pretty well within budget for the construction to date as well. There’s still plenty of time for items to end up more expensive than we anticipated, so I don’t want to get overconfident just yet, but so far so good.

I want to take a moment here to give a number of kudos to our executive director, Steve Fitzer. He has done an excellent job of managing the medical society’s finances this year, and fiscally we are in very good shape at this point in the budget year. He and the rest of the staff have really come through for us in their efforts. The financial strength of the medical society over the past two years has made it possible for us to get very competitive financing for the building construction costs which were not covered by the money from the sale of the old building on French Street. My congratulations and thanks go out to all the staff for the work they have done so well for us.

Additionally, Steve has shouldered the vast majority of the burden in fundraising for the building and the BCMS Capital

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Campaign also is going very well. We have gotten a number of large donations from local businesses to help fund our construction, and Steve has been our chief salesman in that regard. A number of members of the medical society have really come through for us as well, by making additional contributions above and beyond the special assessment added to the dues this year and next year — in some cases going way above and beyond. I want to especially recognize their generosity and enthusiasm for our new home. We are welcoming any donations toward this effort, of course, regardless of size, and thanks to everyone who has contributed.

The best update for the building progress is to simply drive out to Loop 1604 between Interstate 10 and N.W. Military Drive, and take a look at the south side of the road, now that the walls have been raised. In theory, the groundbreaking was the point where the new building transitioned from dream to reality, but for me that point arrived when the walls went up and you can actually see the place. Drive by and have a look when you get a chance. It’s hard not to get excited about the project when you see it firsthand.

James L. Humphreys, MD, is the 2015 president of the Bexar County Medical Society. He is a pathologist with Precision Pathology in San Antonio.

BCMS ALLIANCE

BCMSA Scholarships awarded to distinguished students

By Rebecca Christopherson, 2015 BCMS Alliance President As an organization dedicated to the betterment of our community, the BCMS Alliance continually endeavors to assist young students entering healthcare-related fields with the burdensome cost of their post-secondary education. At the Bexar County Medical Society’s annual New Member Welcome, held June 3 at the University of the Incarnate Word Rosenberg Sky Room, seven deserving high school seniors each were awarded a $1,000 scholarship. Each award is renewable for up to three years to help defray educational expenses as the talented students pursue degrees in healthcare-related fields.

Cindy Comfort, Alliance scholarship chair and immediate past president, announced each recipient’s name as she presented the winners with certificates and their checks. Scholarship awards were based on grade point average, class rank, SAT scores and financial need. The following students were recognized as the 2015 BCMSA Scholarship recipients: Victoria Almanza, Annette Barraza, Karla Estrada, Lindsey Gutierrez, Audrianna Martinez, Alexis Montoya and Samantha Van Koughnet. I think I can proudly speak for all BCMS Alliance members as I extend a very hearty congratulations to each and every one of these well-deserving students. Well done, and we wish you the best of luck!

Also this summer, Jennifer Lewis and I were fortunate to be able to attend the 2015 AMAA Conference in Chicago on June 6-9. Jennifer and I attended a variety of leadership and membership enrichment meetings. We also took the opportunity to visit the Art Institute of Chicago.

Until next time, take care!

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BCMS NEWS JANIVEE BARRON NAMED BCMS UNSUNG HERO FOR JUNE Janivee Barron, chief operating officer at Vital Life Wellness, was named the BCMS Unsung Hero for June.

In nominating her, Ms. Barron’s colleagues said she is very organized and has been instrumental in implementing new service lines and overall comprehensive wellness programs.

“She monitors the pulse of the practice and helps maintain high quality and patient overall experiences,” according to the nomination letter.

The Unsung Hero program recognizes physicians’ office managers and administrative staff who help BCMS members deliver the best quality care to patients. Winners receive gift certificates and are eligible for annual prizes. To learn more, visit www.bcms.org.

plus — a one-year transition grace period. As you will recall, TMA, along with the state associations of California, New York and Florida, recently urged CMS for a two-year, penalty-free and auditfree grace period. With the Oct. 1 deadline less than three months away, TMA has compiled a number of resources to assist physicians with preparations for the roll-out.

To read the CMS/AMA announcement and comments from TMA President Tom Garcia, MD, and to access TMA’s resource link, go to http://www.texmed.org.

For local discussion on this and other practice management and legislative advocacy topics, consider joining the BCMS Legislative and Socioeconomics Committee by contacting Mary Nava by email at Mary.Nava@bcms.org.

CAPITAL CAMPAIGN UPDATE

Interior of new BCMS office takes shape Thank you, Capital Campaign contributors!

(From left) Roxanna Cervantes, Ramona Rundle (in back), Vaneza Guzman, Megan Juarez, Erica Garcia (in back), Dr. Bernice Gonzalez, Unsung Hero Janivee Barron, Jennifer Lefner, NP, Stephanie Thomas, DNP, Cynthia Ayala and Luke Wempe.

IN MEMORIAM Colette M. Kohler, MD, died June 1, 2015, at age 84. Dr. Kohler was San Antonio’s first pediatric cardiologist and a BCMS retired member.

Arthur S. McFee, MD, PhD, age 83, died June 20, 2015. A general surgeon, Dr. McFee served in the U.S. Navy and was a BCMS life member.

Bernard W. Palmer, MD, died June 23, 2015, at age 80. Dr. Palmer, an otolaryngologist, was a BCMS life member.

BCMS LEGISLATIVE AND ADVOCACY NEWS

CMS answers call to help physicians convert their practice to ICD-10 Mandatory roll-out begins Oct. 1 with a one-year transition grace period

By Mary E. Nava, MBA Chief Governmental and Community Relations Officer The Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) have announced they will continue in their educational efforts so that physicians are ready for the Oct. 1 switch from ICD-9 to ICD-10 coding, with an added 12 San Antonio Medicine • August 2015

Construction continues on schedule at the new BCMS office, 4334 North Loop 1604 West. Workers recently completed the second-floor beams, joists and deck, and prepared to pour the secondfloor concrete. Roofing also has begun.

BCMS wishes to thank the following donors for their generosity in making this project possible: Luminary Level - $50,000 Frost Trust Innovator Level - $25,000 BB&T Favorite Staffing Gastroenterology Consultants HEB Mednax/Pediatrix Northside Ford

Benefactor Level - $5,000 Dr. Chad and Rebecca Christopherson Dr. Del and Louise Chumley Dr. Gerald Greenfield Gunn Dealerships Dr. David Henkes Kahlig Auto Group Drs. Malathi and Vijay Koli Nix Health Dr. and Mrs. Neha and Jayesh Shah

Capital Campaign contributors will be recognized on a donor wall at the new building. For more information and to donate, visit www.bcms.org.

SPECIAL-NEEDS CHILDREN

‘Taking Flight,’ a massive bronze sculpture, greets Morgan’s Wonderland guests.

Butterfly theming throughout the 25-acre park reminds special-needs guests they can ‘spread their wings’ and build confidence doing fun things thought not personally possible. Photo by Robin Jerstad

The healing power of

Morgan’s Wonderland Special to San Antonio Medicine

In its five busy years of existence, Morgan’s Wonderland not only has become known as a fun place but also as a place of rehabilitation and healing.

The fully-accessible theme park in Northeast San Antonio – the only one of its kind in the world – opened in spring 2010, and since then, it has welcomed more than 500,000 guests from all 50 states and 54 other countries. The park’s 25 attractions, including rides, playscapes, gardens and other facilities, enable those with cognitive or physical challenges to do the same things as individuals without disabilities and boost their confidence in a safe, colorful, affordable atmosphere of enjoyment.

“I couldn’t begin to give you a number as to how many lives Morgan’s Wonderland has touched,” said Gordon Hartman, CEO of the Gordon Hartman Family Foundation, who, along with wife Maggie, spearheaded creation of the unique park. “But I believe it’s a big number. Special-needs guests immerse themselves in having fun with family and friends, and they surprise and amaze themselves in doing things they thought were not personally possible.”

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SPECIAL-NEEDS CHILDREN THE POTENT POWER OF INCLUSION As an example, Hartman points to special swings in which guests in wheelchairs can experience the thrill of a taken-for-granted playground pleasure, many of them for the first time.

The Morgan’s Wonderland guiding principle is the potent power of inclusion. “Morgan’s Wonderland is a special place where anyone can have fun,” Hartman said, “but it was created with specialneeds individuals in mind. It’s just like any other theme park except for the added benefit of a culture and environment that assures 100 percent enjoyment by everyone who enters through our Welcome Center. Unfortunately, countless children and adults with special needs don’t have access to facilities that can help them fully enjoy outdoor recreation. We truly believe Morgan’s Wonderland is changing that.”

In 2005, Hartman sold a successful homebuilding business to establish his philanthropic family foundation and pursue a dream of helping specialneeds children and adults. The Hartmans’ devotion to this cause is inspired by their 21-year-old daughter with special needs, Morgan. Her soaring spirit despite multiple challenges sparked within them a deep desire to create Morgan’s Wonderland, a haven not only for special-needs individuals but also for their families, caregivers, friends and the general public. Anyone with a physical or cognitive special need is admitted free of charge.

VacationHomeRentals.com, an affiliate of Trip Advisor, recently named Morgan’s Wonderland the “best family attraction” in Texas. The 25-acre park has become the anchor of Wonderland, Texas, a family destination in the former Longhorn Quarry that exists for fun as well as helping the specialneeds community. Other attractions are the South Texas Area Regional (STAR) soccer complex, with 13 first-class lighted fields for league and tournament play; the San Antonio Scorpions pro soccer team, 2014 North American Soccer League champions; Toyota Field, the multi-purpose stadium home of the Scorpions; and Monarch Academy at Morgan’s Wonderland, a school for students with special needs ages 12 through 24.

Top: The Children’s Rehabilitation Institute of TeletónUSA partnership with Morgan’s Wonderland enables young patients with physical disabilities to do some of their physical therapy sessions in the park. Photo

by Brenda Pena. Bottom: Morgan’s Wonderland guests in wheelchairs can experience the thrill of a taken-for-granted pleasure thanks to special swings. Photo by Robin Jerstad Continued on page 16 visit us at www.bcms.org

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SPECIAL-NEEDS CHILDREN Continued from page 15

All net profits from STAR Soccer, the Scorpions and Toyota Field flow to Morgan’s Wonderland to help defray operating expenses as well as expand special-needs programs and services. The Scorpions franchise is the first in professional sports to exist solely for the benefit of a nonprofit.

Thanks to support from the Scorpions and generous donors, Morgan’s Wonderland also blends fun with rehabilitation. The South Texas Regional Adaptive and Paralympic Sports (STRAPS) program enables athletes of all ages with physical disabilities to compete in eight programs – wheelchair soccer, powerchair soccer, Paralympic soccer, goalball (a sport similar to soccer for visually impaired athletes), wheelchair football, wheelchair basketball, wheelchair softball and Boccia. STRAPS is already a recognized community partner of the United States Olympic Committee (Paralympic Division) as a U.S. Paralympic Sports Club. STRAPS athletes pursue scholarships to play Paralympic sports in college and membership on Paralympic national teams.

A PLACE FOR FUN, HEALING The newest Wonderland, Texas, neighbor also specializes in rehabilitation. The Children’s Rehabilitation Institute of TeletónUSA (CRIT USA) is a nonprofit rehabilitation center for children who are born with or who have suffered neurological, muscular or skeletal disorders and injuries. (See story on page 18.)

“We’re absolutely delighted that CRIT USA decided to locate in San Antonio,” Hartman said, “and we’re thrilled they’ve partnered with Morgan’s WonTop: Equicizer mechanical horses in the Sensory Village at Morgan’s Wonderland build strength, balance, flexibility and confidence.

Photo by Robin Jerstad. Middle: The South Texas Regional Adaptive and Paralympic Sports (STRAPS) program at Morgan’s Wonderland enables athletes of all ages with physical disabilities to compete in eight sports. Photo by Robin Jerstad.

Bottom: The Children’s Rehabilitation Institute of TeletónUSA partnership with Morgan’s Wonderland enables young patients with physical disabilities to do some of their physical therapy sessions in the park. Photo by Brenda Pena.

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SPECIAL-NEEDS CHILDREN

derland so their patients can undergo physical therapy sessions in our colorful park. It’s wonderful to see patients, their therapists and family members making use of our outdoor playground equipment and other attractions at Morgan’s Wonderland.

“Morgan’s Wonderland truly is a special place for fun and healing, and there’s much more to come.”

An aerial view of Morgan’s Wonderland, with Toyota Field, home of the North American Soccer League San Antonio Scorpions, in the background. Photo courtesy Morgan’s Wonderland.

To learn more about Morgan’s Wonderland, visit www.MorgansWonderland.com.

Additional information is available at www.SAScorpions.com, www.MonarchAcademy.net and www.STRAPSsports.com.

visit us at www.bcms.org

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CARE SYSTEM PROFILE

Courtesy photos

Children’s Rehabilitation Institute of TeletonUSA Internationally recognized pediatric model of rehabilitative care opens first U.S. facility in San Antonio

By Ellie Leeper, CRIT USA Public Relations Manager EDITOR’S NOTE: This is the tenth article in a planned series of Care System Profiles, highlighting various healthcare providers in Bexar County in the pages of San Antonio Medicine. The goal of the series is to inform BCMS members about the relationships that exist within and among various local institutions. Articles will focus on what distinguishes one system from another, and what is unique about each organization.

Representatives of local healthcare delivery systems are being invited to submit an article describing their institutional initiatives for publication in the series. Organizations are featured in the order in which their articles are submitted and approved. Members of the BCMS Communications/Publications Committee review articles before publication, and content may be edited for format, style and clarity. For guidelines and more information, email editor@bcms.org. To read past articles, visit http://www.bcms.org/SAM.html.

Who are the legal owners of this institution?

Who is served by this healthcare delivery system?

The Children’s Rehabilitation Institute of TeletonUSA (CRIT USA) is owned and operated by the TeletonUSA Foundation, a nonprofit organization established in 2011 that raises funds through an annual telethon to benefit children’s healthcare organizations. CRIT USA is the primary beneficiary of these funds; however, the TeletonUSA Foundation also has donated to organizations throughout the United States that specialize in the fields of pediatric rehabilitation, cancer and autism. Our address is 10839 Quarry Park, San Antonio, TX 78233. We have only one clinic in the United States, located here in San Antonio.

CRIT USA offers pediatric care for children ages newborn to 18 years old with neuromuscular and skeletal injuries or disorders. Our model of care also includes psychological and emotional support for family members of patients, as they are incorporated into and coached through each child’s customized treatment plan. CRIT USA has the capacity to treat 600 children and their family members annually; offering between 80 and 100 services to patients, and is currently operating at full capacity. CRIT USA is treating patients from San Antonio and throughout Texas, as well as patients from more than 40 U.S. states.

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CARE SYSTEM PROFILE

How is this institution funded or financed, and how successful is the funding?

Currently, all capital funds and first-year operating funds have been secured through private donations and individual donations during the annual TeletonUSA telethon. The event has proven to be very successful, raising more than $15 million during each broadcast, and TeletonUSA has hosted three consecutive 30-hour live broadcast events since it was established in 2011. The majority of the funds have been allocated to the construction and operation of CRIT USA. A separate project is under way to secure private operational funds for the future.

habilitation (PM&R), general pediatrics, neurology, nutrition, nursing, family psychology, social work, and a therapy team comprising physical therapy, occupational therapy, respiratory therapy, and speech and language therapy. Each child is evaluated by these professionals, and receives a personalized treatment plan established by our PM&R doctors. Throughout months or years of outpatient therapy in our facility, families work with the medical team to achieve patient goals that increase quality of life and every-day function.

Upon achievement of their therapy goals, children then graduate from our system.

How does this care system operate?

What types of business relationships exist within this organization, particularly with physicians?

As an organization whose mission is to increase the quality of life for children with neuromuscular and skeletal challenges, it has been woven into the foundation of the institution to treat our patients and their families regardless of insurance situation or ability to pay. We are strongly committed to offering comprehensive care for our families at an extremely low cost for services. Many families will pay as little as $1 or $5 for their visits. Many of our patients have been selfreferrals, although we have had patient referrals from various institutions.

Our model functions by having a diverse medical team practicing full-time in our facility. We have pediatric physical medicine and re-

We have partnered with the University of Texas Health Science Center San Antonio and the University of the Incarnate Word to establish a therapy clinical site program at CRIT USA. Students studying physical and occupational therapy will use our facility as one of their rotation locations, offering them a glimpse into working with a holistic and comprehensive chronic treatment model.

We also have partnered with Morgan’s Wonderland, our next-door neighbors (see page 14), to develop an outdoor therapy plan for our patients. Our physical and occupational therapists and our speech and language pathologists will use the park’s attractions as alternative outdoor spaces to treat patients.

Continued on page 20 visit us at www.bcms.org

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CARE SYSTEM PROFILE Continued from page 19

Are there future plans, goals, and/or announcements to be made at this time?

We have been working to establish various clinics for our patients and their families. We are excited to announce that we will be offering an orthotic and prosthetic clinic with Hanger Orthotics, Orthotics Plus, and Ritchie Limb and Brace. We also will offer a wheelchair clinic with NuMotion and Allstar Medical.

What is the one main thing BCMS members should know or remember about this care system?

Members of the Bexar County Medical Society should remember that CRIT USA is a nonprofit organization that provides state-ofthe-art comprehensive care to children and their family members for as little as $1 per visit, depending on a family’s ability to pay. We will treat patients whether or not they have insurance, and we are working toward our CORF accreditation that will allow us to bill Medicaid and CHIP programs. We treat mild to severe cerebral palsy and brain injury, neuromuscular disorders, skeletal disorders, spinal cord injury, amputees, congenital and genetic diseases, and we provide early

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childhood intervention. Although we are operating at full capacity with 600 patient slots filled, we will accept referrals for trauma and acute illness requiring care. Please do not hesitate to contact us directly if you have a patient who has suffered an acute brain or spinal cord injury and needs outpatient treatment.

How are patients referred to CRIT USA? To refer a patient to CRIT USA, we have an open-enrollment phone line that families may call at 1-844-206-4512. If a physician needs to refer a child to our facility, he or she may contact Dr. Ellen Leonard, our Chief Medical Officer, at leonard@critusa.org or 210888-7424.

Ellie Leeper serves as public relations manager for the Children’s Rehabilitation Institute of TeletonUSA. Leeper was born and raised in San Antonio and earned her B.A. degree in communication from Trinity University.

BUSINESS OF MEDICINE

IS YOUR BONUS ‘reasonable’ compensation?

By Pamela C. Smith, PhD You consider yourself a successful physician: You own your own specialty practice, have numerous locations, employ well-qualified staff and administrators, employ some of the best and brightest physicians, and you own it all. Your closely held business generates more than $15 million in total billings for the year. Your practice keeps you very busy – you see patients, perform surgeries, and you’re deeply involved with the managerial tasks of the business. Since you are so engaged, you carry many titles – CEO, president, COO, and medical director – just to name a few. The many hats you must wear might increase your stress level, but your efforts do not go unnoticed. You are able to collect a basic salary of more than $700,000 per year, but your successful juggling of tasks and increased workload are also well worth the $2 million end-of-year bonus. You were the one who brought in more than 25 percent of the billings for the year, so that bonus is well-deserved.

IRS MAY DENY BONUS To the average physician, who is aware of the stress, demanding schedule and expertise needed in today’s environment, this compensation arrangement appears sufficient. To the Internal Revenue Service (IRS), however, the bonus amount might not be completely reasonable. The IRS and the tax law require compensation to be reasonable, considering all facts and circumstances. Otherwise, the compensation deduction will be denied for tax purposes.

The above scenario occurred in a recent tax court decision, Midwest Eye Center, S.C. v. Commissioner1. The IRS denied $1 million of the total $2 million bonus, arguing the taxpayer failed to establish the reasonableness of the bonus. The eye surgery center failed to prove the bonus was reasonable because it did not provide any evidence of comparable salaries, and failed to show exactly how the bonus was calculated. Furthermore, the center failed to substantiate why the bonus was paid in four equal installments at the end of the year.

Taxpayers are allowed to deduct eligible expenses, as a matter of legislative grace, as long as the expense is considered “ordinary and necessary.” Salaries and bonuses also must be deemed to be (1) reasonable in amount and (2) paid or incurred for services actually rendered2. What is defined as “reasonable” is all based on the facts and circumstances of each particular situation. For bonuses, the tax regulations stipulate they are deductible “when … made in good faith and as additional compensation for the services actually rendered by

the employees, provided such payments, when added to the stipulated salaries, do not exceed a reasonable compensation for the services rendered.”3 Items that can help substantiate the reasonableness include evidence of comparable salaries. In Midwest Eye Center, they did not provide any such evidence. They argued there were no “like enterprises” under “like circumstances” for which to draw comparisons. The physician’s increased workload and various roles (CEO, CFO, etc.) were the reason for the bonus. This “reason” was not substantiated with any methodology for calculating the bonus relative to those responsibilities.

This lack of substantiation led to the denial of part of the bonus deduction – which led to an underreporting of income – which sparked the application of accuracy-related underpayment tax penalties.

WHO PREPARED THE RETURN The next logical question in this story might be: Who prepared this tax return? Why is that paid-preparer not responsible for some of this? In the Midwest Eye Center case, the company failed to provide any evidence concerning the identity of the paid tax preparer, what type of information the center provided to the preparer, or even whether or not the center relied on the preparer’s judgment.

The moral of this story: reasonableness of compensation should not be ignored. Your opinion of your expertise, brilliance and cutting-edge technologies may not be sufficient to justify your compensation package arrangement. From the government’s perspective, it is unlikely your situation is so unique that a “comparable enterprise” with “like circumstances” does not exist. Medical practices and physicians are encouraged to employ competent advisors that understand and follow tax laws. With proper consultation and methodology, the next Midwest Eye Center case should not occur.

REFERENCES 1 Midwest Eye Center, S.C. v. Commissioner, TC Memo 2015-53.

2 See Treas. Reg. §1.162-7(a) 3 See Treas. Reg. §1.162-9

Pamela C. Smith, PhD, is a professor in the department of accounting at the University of Texas at San Antonio.

visit us at www.bcms.org

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BUSINESS OF MEDICINE

TRUST: WHAT SUCCESSFUL PEOPLE KNOW

By Jill Koob

Trust me. It’s critical to sustainable success.

In recent years, “hope” seems to be the buzz word, but “skepticism” is the reality. With almost daily announcements of new compliance requirements and the healthcare industry squeezed to do more with less or face severe financial consequences, employees and employers alike are hunkering down and preparing for the worst.

The byproduct is low trust, secrecy and less communication. Not surprisingly, this creates low morale resulting in less productivity and, ultimately lower profits.

The good news? For companies, this is the perfect opportunity to set themselves apart from the competition and create a hightrust work environment, which will reap the advantages of attracting and retaining top talent as well as customer confidence in the process. For employees, it is an opportunity to make a real difference in their work environment and help them create an individual path to success.

Let’s first look at how “trust” is defined. Author Stephen M.R. Covey describes trust succinctly utilizing four core elements, in his book, “The Speed of Trust”: CHARACTER: Core 1 — Integrity (courage to act in accordance with your values and beliefs) Core 2 — Intent (motives, agendas and resulting behavior) COMPETENCE: Core 3 — Capabilities (talents, attitudes, skills, knowledge and style) Core 4 — Results (track record, performance, getting the right things done) 22 San Antonio Medicine • August 2015

Think for a moment about an employer, supervisor, co-worker, or employee that you just didn’t trust or perhaps betrayed your trust.

Was it character or competence that led you to your decision? Or both? The answer(s) will help define “trust” for you on a much more personal level.

“Low-trust organizations are characterized by manipulation, secrecy and the triumph of shrewd calculation over hard work. Hightrust organizations, on the other hand, are rewarded with a culture that supports creativity and collaboration among its members,” write Don Cohen and Laurence Prusak in their book, “In Good Company.”

HOW LEADERS BUILD TRUST The rewards of a high-trust environment are clear. But attaining trust requires time, attention and work. For example, you may have stellar credentials and have led many successful teams in the past, but the new team you were just hired to lead needs to learn who YOU are before they will truly trust you. They need to understand your character and motivations.

In our fast-paced world, are there any shortcuts to this process?

Not really. And, when you try and take the fast track you risk harming your reputation. Be patient.

Following are eight trust-building ideas: 1. Consistently observe your own motives (think “win/win”). Ask yourself: Am I interested in growing my team professionally? Am I looking for win/win solutions in all my relationships?

2. Communicate with candor (tactfully/respectfully). Jack Welch dedicated an entire chapter in his book, “Winning,” to this very subject.

BUSINESS OF MEDICINE 3. Don’t use truth as a weapon (overuse or misuse of the “truth” will not win trust). Look at your motive when revealing information.

Are you betraying a confidence? What purpose will it serve to share this “truth”?

4. Avoid passive/aggressive behavior (yikes!) You know who you are.

This behavior is definitely a trust killer!

5. Give credit (always!) Do not ever take credit for others’ work, ideas or efforts. If you want to build a dynamic, effective group, identify team members’ efforts and publicly praise them, frequently.

6. Set CLEAR expectations (be specific and realistic). The most trusted and effective leaders set clear expectations for their team and hold people accountable for results.

7. Communicate, communicate and communicate some more (listen!) It’s important to hear what your team is saying. Keep your ear to the ground and hear the musings and rumblings as well. A smart leader will address issues and dispel rumors openly, as well as allow for two-way communication.

8. Honor others in their absence (don’t gossip!) Successful leaders don’t gossip. If you are in a position of leadership, you have a responsibility to be honorable and address issues directly. A sure way to lose respect along with trust is to gossip.

Assess yourself: The Speed of Trust online assessment will help you to identify your credibility with others and offers a test on whether you practice the 13 trust behaviors or their more common counterfeits (www.speedoftrust.com).

The Trust Leader online leadership assessment is a starting point to becoming a trusted leader (www.thetrustedleader.com).

HOW EMPLOYEES CAN BUILD TRUST So, you come to work every day and hide behind your desk. You are miserable, because the “practice/leader/boss” [you fill in the blank] does not keep you informed! They are so secretive. You just know something bad is about to go down. You plan to stay below the radar and keep plugging along. You know who I’m talking about.

I’ve been there, too! Trust is a two-way street. As an employee, you have responsibility in a low-trust relationship.

Following are eight trust-building ideas employees can utilize for success: 1. Contribution (adding value to the team/company). Ask yourself: Am I truly adding value to the organization? If not, what clarifying questions, support, tools do I need to be successful? Once you have the answer – ask for what you need!

2. Communicate with candor (tactfully/respectfully). Be cautious.

Too much candor can lead to termination, if you are not careful.

Adjust your style to your supervisor – start slowly and increase speed, if well taken.

3. Don’t tattle (no one likes a tattle tale!) This is not building trust; it actually destroys camaraderie and trust. Check your motives – if it violates policy or the law, you may not have a choice, but if your co-worker shows up 10 minutes late, don’t run to your supervisor!

4. Avoid passive/aggressive behavior (yikes!) Again, if there are issues that are bothering you, address them immediately. Don’t be the powder keg that explodes because there is no creamer left in the kitchen. Truly, this behavior is definitely a trust killer with both your co-workers and supervisor.

5. Give credit (always!) As with supervisors, you should never take credit for others’ work, ideas, or efforts. Giving credit to fellow team members for their work will help you build camaraderie with your team members as well as earn you respect from your supervisor.

6. Deliver results (be specific and realistic). Set achievable expectations and deliver quality, on-time results. If you miss a deadline, don’t give excuses! Apologize for not meeting the expectations and figure out how you can meet the set objectives in the future. Remember, successful people make mistakes, but what differentiates them from unsuccessful people is they have integrity, take responsibility for their actions and make sure they figure out how to deliver in the future.

7. Communicate, communicate and communicate some more (listen!) It’s important to hear what others are saying (including your co-workers and supervisor). If you need more information, ask. If you have a question, ask. If you don’t understand the objective, ask. Asking questions, the right questions, is critical to your future success.

8. Honor others in their absence (don’t gossip!) This is so hard to do, especially in a low-trust environment. But please resist the temptation. I understand that your boss or co-worker may drive you nuts, but see if there is a better way to relieve your frustration.

Maybe change your perspective and address the issue directly with the person. It’s your first step in becoming a leader yourself and making a real change.

Jill Koob is vice president-client services for Employer Flexible, a BCMS Circle of Friends sponsor at the gold level. For more information, visit www.employerflexible.com.

This information is provided on behalf of a valued BCMS Circle of Friends sponsor at the gold level, but it is not an endorsement.

BCMS thanks its Circle of Friends sponsors; their donations help keep down the cost of dues and allow BCMS to continue to provide quality service to its members. The society continues its pledge to you and only will involve itself in services and programs that benefit you, the member, and your patients. visit us at www.bcms.org

23

NONPROFIT

Any Baby Can serves families facing health, developmental challenges Special to San Antonio Medicine Courtesy photos

In 1982, Marian Sokol, PhD, a special-needs teacher, saw a need among the families she served. With a small grant and a trailer behind Santa Rosa Hospital, she began her mission of helping families with children who

CASE MANAGEMENT

there was indeed a great need in the

The mission of Any Baby Can is to serve families with children and youth facing serious health or developmental challenges. All services are free for families who reside in Bexar County or one of the 18 surrounding counties, regardless of income.

Highly experienced case managers are at the forefront of Any Baby Can’s mission.

Case managers are available to help review information about programs and community resources, they direct families to Any Baby Can programs, and link families to local and state programs. Families of children who have been diagnosed with a chronic illness, disability, or development delay also may qualify to receive crisis assistance.

community for case-management

How to qualify:

had a chronic illness, disability or developmental delay.

To her surprise, she received more than 500 phone calls for help within the first six months, and she realized

support and information on how families could receive help in time of hardship. Fast-forward 30 years later, and Any Baby Can is still doing

• A child in the family must have a diagnosis from a physician/doctor/medical evaluator/development specialist or have a suspected illness or disability.

• Child must be from birth through 17 years of age.

• Child must reside in one of the following counties: Bexar, Atascosa, Bandera, Blanco, Caldwell, Comal, Edwards, Frio, Gillespie, Gonzales, Guadalupe, Hays, Kendall, Kerr, Kimble, Medina, Real, Uvalde or Wilson.

much of what Dr. Sokol did but with

AUTISM SERVICES

expanded services to address the ever-

Any Baby Can’s autism services program is designed specifically for families who have a child diagnosed with Autism Spectrum Disorder. The organization provides parent education and support through a variety of services such as parent training,

growing needs of the community.

24 San Antonio Medicine • August 2015

NONPROFIT

group and individual counseling, education groups, toilet training, parent’s night out and safety training.

Its group parent training course supports parents by increasing their knowledge of how behavior is learned and the underlying function or purpose of their child’s challenging behaviors. Parents learn as a team what the meaning is behind their child’s behaviors and how to address these behaviors in their daily life. Parents are supported by experienced and credentialed staff who assist them in meeting their child’s behavioral needs.

PRESCRIPTION ASSISTANCE Any Baby Can’s prescription assistance program enables families without medical insurance or who have exhausted all other insurance resources to apply for free or low-cost prescription drugs. Individuals may qualify if they have a chronic condition and meet one or more of these guidelines: • No health insurance or limited benefit coverage, • Exhausted coverage on Medicaid, • Exhausted coverage on Medicare Part D, • Pending CHIP or Medicaid, • Have a chronic condition and need to receive medications regularly, • Meet the income guidelines set by the pharmaceutical company, • Have a regular physician.

Prescription assistance services are offered in Any Baby Can’s San Antonio and New Braunfels offices to individuals residing in Bexar, Bandera, Comal or Kendall County. Adults are welcome to apply.

HEALTH AND WELLNESS In the area of health and wellness, Any Baby Can offers a daily exercise program designed specifically for people with unique learning abilities. The organization strives to promote optimal health, physical fitness, and inclusion of individuals diagnosed with developmental disabilities through the offerings of recreational fitness, fitness exploration, support and education.

Any Baby Can program services include: weekly visits from an adaptive fitness specialist and nutrition education, Any Baby Can

exercise kit, a wellness navigator and individualized fitness agenda.

Services are available to families with a school-age child/adolescent, 4 to 21 years of age, diagnosed with a developmental disability. All services are provided free of cost and are available for residents in Bexar and Comal counties.

INFANT AND CHILD LOSS The Center for Infant and Child Loss has been a program of Any Baby Can since 1984. The purpose of this service is to provide support to families who have experienced the tragic loss of their infant or young child due to any cause. The center’s services include funeral assistance, individual and family counseling, grandparent support group, quarterly grief support newsletter, annual candlelight memorial service, and grief support literature for bereaved families. Infant and child loss services are offered at the organization’s Bexar, Comal and Kerr county locations.

SIBLING SUPPORT Having a sibling with special needs creates its own unique set of challenges and experiences. Sometimes siblings feel alone and left out; because of this, Any Baby Can offers a sibling support group.

Its objectives are for each child to gain an understanding of different disabilities and chronic illnesses affecting their siblings; for each child to see that they are not alone; to use art activities and book readings to help kids explore feelings they may experience, such as resentment, jealousy, guilt, anger, happiness, loneliness, pride, love and embarrassment; and to help kids develop self-esteem and skills to solve problems they may have with peers, their siblings, or at school or home. The sibling support group is for children ages 6 to 14 years of age and is facilitated by a licensed psychologist in Bexar and Comal counties.

To better serve families, Any Baby Can has onsite case managers at Santa Rosa Children’s Hospital and Methodist Children’s Hospital.

For more information about Any Baby Can of San Antonio or to request services, visit www.anybabycansa.org or call 210227-0170.

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25

LIFESTYLE

2015-16 arts season to offer dynamic performances

By Julie Catalano The Book of Mormom National Tour © Joan Marcas, 2013

Fall soon will be in the air and that means the curtain is about to rise on an exhilarating new performing arts season in San Antonio. Dozens of dynamic offerings are waiting in the wings — dance, drama, Broadway musicals, concerts and more, poised to make a dazzling entrance in what promises to be one of the best seasons ever. Read on ...

The Little Mermaid, Photo by Music Theatre of Wichita

MAJESTIC THEATRE Broadway in San Antonio is celebrating its 25th year in the Alamo City. “This is a landmark season for the Majestic Theatre,” said Mike Rilley, general manager of the Majestic and Charline McCombs Empire theaters. “This season once again celebrates the diversity of Broadway and brings its biggest hits along with widely loved family classics.”

The 2015-16 North Park Lexus Broadway in San Antonio series begins with the Theatre Under the Stars’ production of Disney’s The Little Mermaid (Sept. 22-27). November brings megastar producer Cameron Mackintosh’s new production of The Phantom of the 26 San Antonio Medicine • August 2015

Opera (Nov. 5-15), hailed by critics as “bigger and better than ever before.” Back by popular demand is The Book of Mormon (Dec. 15-20), from “South Park” creators Trey Parker and Matt Stone and called “the best musical of this century” by The New York Times (production note: explicit language).

The new year kicks off with Kinky Boots (Jan. 2631), an uplifting tale inspired by a true story and a feel-good score by Cyndi Lauper. Rodgers and Hammerstein’s Cinderella (April 5-10) and its beloved songs will transport adults back to their childhood with a lush production and some new twists. Motown the Musical (May 3-8) tells the story of Motown founder Berry Gordy, the music mogul who launched the careers of many Motown legends, and features more than 40 Motown classics.

Closing out the season is a completely re-conceived production of The Wizard of Oz (May 31-June 5), developed from the MGM screenplay and containing the film’s original songs plus new ones

by Tim Rice and Andrew Lloyd Webber. The New York Post praised its “gorgeous sense of spectacle.”

Season options include the 20th anniversary tour of Riverdance (Feb. 26-28) and Disney’s Beauty and the Beast (Oct. 16-18).

For complete schedule and ticket info: broadwayinsanantonio.com, 800-215-SHOWS (7469).

Saturday Night Fever, Courtesy image, Tobin Center

LIFESTYLE

THE TOBIN CENTER FOR THE PERFORMING ARTS The second year of the brand-new Tobin Center is coming out of the chute like gangbusters, with more artists and performances than can be listed here. Some highlights: The BMW San Antonio Signature Series has a boffo Broadway series lined up, beginning with FlashDance the Musical (Oct. 20), the ’80s pop-culture phenomenonturned-electrifying musical. A Mel Brooks classic movie takes a musical turn in The Producers (Jan. 13), a hilarious hit that took a record 12 Tony Awards. Another movie favorite by Woody Allen, Bullets Over Broadway (March 6), has mobsters aplenty with a Roaring ’20s-style score.

One of the most popular coming-of-age stories of all time, Saturday Night Fever (March 28) follows the iconic character of dancer Tony Manero in 1970s Brooklyn, with legendary hits by the Bee Gees along with new songs especially for this production. A huge, sold-out hit last year, Rudolph the Red-Nosed Reindeer (Dec. 21-24) is back to delight audiences of all ages.

A special show in the subscription series, The Midtown Men (Oct. 14) is a concert program featuring members of the Broadway smash hit Jersey Boys, the story of Frankie Valli and the Four Seasons.

The dance series will present audience fa-

vorite Ballet Folklorico de Mexico (Sept.

14), the mesmerizing Forever Tango (Nov. 10), and two San Antonio firsts — the electrifying troupe Shaping Sound (Jan. 26), and Blaze (Feb. 18), showcasing the best in street dance and break dance. Celtic Nights (March 24) takes a musical journey through Ireland. Ballet Alive! (April 8-10) by the Tobin’s resident ballet company Ballet San Antonio also may be added to the dance subscription series.

The Tobin Center’s EDGE Series debuts this season — a bold, ultra-modern and adults-only series staged in the Carlos Alvarez Studio Theater. Seven off-Broadwaystyle shows are “provocative, fun, engaging theater for the contemporary audience,” said Aaron Zimmerman, senior director of programming and marketing. The opener is One Man Breaking Bad (Sept. 12), described as “one man, 60 minutes, 60 episodes and shedloads of knowledge.”

For complete schedule and ticket information: tobincenter.org, 210-223-8624.

SAN ANTONIO SYMPHONY The San Antonio Symphony’s 2015-16 season, under the direction of Sebastian Lang-Lessing, includes a fall gala, winter festival, 32 Classic Series performances, 16 lively Pops Series concerts, and 24 free-admission Young People’s Concerts at the Tobin Center for the Performing Arts in what symphony president David Gross called, “an incredible mix of musical compositions.”

Internationally acclaimed cellist Yo-Yo Ma performs for the fall gala (Oct. 16) in what is sure to be a sold-out performance. (NOTE: At press time, only 2015-16 season subscribers can purchase tickets for Ma’s show; single tickets will go on sale at a later date.)

The Valero Classics Series has a stellar lineup of works, opening on Sept. 18-19 and featuring Beethoven’s Symphony No. 9 and the San Antonio Mastersingers. The fabulous music of George Gershwin is spotlighted (Jan. 15-16) with Rhapsody in Blue and two compositions from Duke Ellington. Other season highlights include works

by Brahms, Rachmaninoff, Mahler and more, spotlighting superb soloists including Sarah Chang (May 20-21) performing Bruch’s famed Violin Concerto.

The H-E-B POPS Series under the direction of associate conductor Akiko Fujimoto is a guaranteed crowd-pleaser with high-energy performances with a contemporary flair. Opening concert I Love a Piano (Oct. 30-31) celebrates songs from Henry Mancini, Elton John, Billy Joel and more.

Bravo Broadway (Feb. 26-27), Bond and Beyond (March 11-12), and Patriotic Pops: Stars and Stripes Forever (May 13-14) round out the highly popular series.

“If you haven’t experienced the symphony before, a pops concert is a great way to introduce yourselves,” Gross said.

For complete schedule: sasymphony.org.

For ticket information: tobincenter.org, or Tobin Center Box Office: 210-223-8624.

Courtesy image, San Antonio Symphony

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27

UTHSCSA DEAN’S MESSAGE

Institute for Health Promotion Research: Real-time, real-world solutions for Hispanic health disparities

By Francisco González-Scarano, MD

The Institute for Health Promotion Research (IHPR) in the UT School of Medicine, founded in 2006, investigates causes and solutions to cancer and chronic disease disparities to improve Latino health in San Antonio and South Texas, and to develop methods that can be used nationally.

Built on a model of research, training and community awareness, the IHPR is directed by health- disparities expert Dr. Amelie G. Ramirez. There, she oversees a staff and faculty that have grown from the original 10 to more than 30. Its official charter is to conduct research, interventions and outreach projects; train scientists and mentor students; and to communicate DR. AMELIE G. RAMIREZ findings and disseminate tools among researchers, academics and the public. They use all of the modern means of communication: websites, social media, news media, public service announcements, newsletters, educational publications and, of course, scientific articles and reports. IHPR researchers have led more than 100 projects to reduce health disparities.

CAREER MISSION In this area no one has more experience and knowledge than Dr. Ramirez, who has a doctorate degree from the UT School of Public Health in Houston. She also is interim chair of the department of biostatistics and epidemiology at the School of Medicine, as well as associate director for cancer prevention and health disparities at the Cancer Therapy and Research Center (CTRC), where she oversees program development, translational research, cancer surveillance data, recruitment, minority outreach and trial accrual. She truly has made addressing Latino health disparity her career’s mission.

Before joining the school, Dr. Ramirez directed the NCI-funded National Hispanic Leadership Initiative on Cancer: En Acción. This was a nationwide study that initiated the first comprehensive assessment of cancer risk factors among the major populations of Hispanic men and women and implemented state-of-the-art cancer prevention and control strategies that were specifically tailored to them.

Since 2000, Dr. Ramirez has served as principal investigator of an-

28 San Antonio Medicine • August 2015

other NCI-funded program, Redes En Acción: The National Latino Cancer Research Network. This program created a national and regional infrastructure for collaboration among advocacy groups, local communities, researchers and public health professionals to stimulate cancer control research, training and awareness. Dr. Ramirez’s work in the fields of behavioral science and health communications has received national attention, including membership in the National Academy of Medicine since 2007 and a presidential appointment to the National Cancer Advisory Board of the National Cancer Institute.

Hispanics tend to have lower income, education, access to healthcare and insurance coverage than the majority population; this places them at a greater risk for disease, and acts in conjunction with other factors such as language barriers and cultural myths to influence health choices. According to Dr. Ramirez team’s research, this may contribute to why Latinos are more likely to forego or delay timely healthcare services for illnesses and injuries, putting them at risk for suffering worse health-related outcomes.

The Census Bureau estimates that Hispanics will make up nearly one-third of the U.S. population by 2050, and it has become even more important to address the wide array of issues surrounding these disparities. Recently, the IHPR and Redes researchers found that Latinas endure a lag in definitive breast cancer diagnosis and treatment initiation. We know that time-to-treatment impacts breast cancer outcomes. So the IHPR and Redes team conducted a randomized controlled trial to test whether patient navigation would improve access to healthcare. Patient navigators, also known as promotoras, typically work with patients to explain and assist with scheduling appointments, understanding test results and treatment options, as well as connecting patients with services like transportation and support groups.

OVERWEIGHT, OBESE CHILDREN The trial proved that navigation can reduce Latinas’ times to diagnosis and treatment and significantly increase the proportion of Latinas initiating treatment. Navigation indeed is likely to have saved the lives of many local Latinas.

In another important health area, an estimated 39 percent of Latino children (ages 2-19) are overweight or obese (a higher percentage than whites and African Americans). This group is at a much higher risk Continued on page 30

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29

UTHSCSA DEAN’S MESSAGE Continued from page 28

for carrying that extra weight into adulthood, bringing a myriad of co-morbidities such as diabetes, hypertension and stroke, heart disease, kidney disease, as well as other nerve and retinal damage.

The IHPR’s Salud America! The Robert Wood Johnson Foundation (RWJF) Research Network to Prevent Obesity Among Latino Children program connects and informs researchers, community leaders, decision-makers and other stakeholders targeting Latino childhood obesity.

Since 2007, its Salud America! has developed an online network of 50,000-plus Latino childhood obesity stakeholders and the first-ever Latino Childhood Obesity Research Priority Agenda. In March 2013, it published a special supplement in the American Journal of Preventive Medicine. The network’s new Salud America! Growing Healthy Change website serves as a clearinghouse of Latino-focused news, maps, resources and Salud Heroes stories to promote healthy changes in communities for Latino kids across the nation.

IHPR research has shown that Latino children are specifically targeted by ads for sugary drinks and also have less access to healthy food choices and to “active spaces,” such as parks and playgrounds for exercise. With that in mind, they created a pilot study – funded by the Center for Medicare and Medicaid Services (CMS) – that did not promote weight loss specifically, but instead targeted a rate of

30 San Antonio Medicine • August 2015

weight gain consistent with healthy growth and development. Based on the results of that pilot study, IHPR researchers successfully competed for a five-year, $2.9 million grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to study this intervention on a larger scale. I believe this will be another of IHPR’s successful demonstrations of how using patient navigation strategies and healthy lifestyles can have a significant impact on a patient population.

The IHPR has stayed very much on the forefront of communications and social media trends, employing the latest in social media including Facebook, YouTube and Twitter to blogging and infographics. Its blog at SaludToday.com has more than 35,000 subscribers and 10,000 followers. Visitors also can find videos, recipes, articles and other relevant health information and resources, including a downloadable cookbook in English and Spanish. The IHPR also has developed various award-winning publications, including Nuestas Historias/Our Stories: Hispanic Women Surviving Breast Cancer (Historias), A Patient Navigator Manual for Latino Audiences: The Redes En Acción Experience (Patient Navigator Manual), and Clinical Trials Outreach for Latinos Program Replication Manual (CTOL).

UTHSCSA DEAN’S MESSAGE

TECHNOLOGY USED IN NEW WAYS The IHPR is using technology in new ways. IHPR researchers have woven text messaging into several healthy lifestyle studies, including a new tobacco-prevention service called QUITXT. In San Antonio, Laredo, Eagle Pass and Del Rio, one in four adults ages 18 to 29 smokes cigarettes and few are reached by services that encourage quitting; this is especially true of Hispanics. The IHPR’s new QUITXT bilingual text-message service, funded by the Cancer Prevention Research Institute of Texas, aims to help young adults in South Texas quit smoking. Smokers will be able to text a code to enroll in the service and get four months of text support and links proven to double their odds of quitting. The service launches this summer.

Dr. Ramirez and the Institute train researchers and educators in behavioral sciences and health promotions. This is one of the more crucial aspects of the IHPR, expanding its reach by sharing its research methods, expertise and materials. The IHPR’s NCI-funded training program, Éxito! Latino Cancer Research Leadership Training, offers an annual summer institute and internships to increase diversity in Latino cancer research by encouraging Latino master’slevel students and health professionals to pursue a doctoral degree and a career in research. As of 2014, 39 percent of all program alumni

have applied to doctoral programs and 27 percent are currently enrolled in a doctoral program. In addition, six indicated they were “confident” or “very confident” they would apply to a doctoral program in the next year, and 15 alumni, in the next five years.

I have no doubt that the work Dr. Ramirez and her team are doing to promote healthful behaviors and eliminate health disparities among Latino populations will have a lasting effect on our local and national populations, as well as advancing how we approach other groups and their disparities. To read about the many different programs at the Institute for Health Promotion Research, or to take advantage of its many resources and materials, visit the main website: https://ihpr.uthscsa.edu where there are links to programs including SaludToday, Redes En Acción, Éxito! and much more.

Francisco González-Scarano, MD, is dean of the School of Medicine, vice president for medical affairs, professor of neurology, and the John P. Howe III, MD, Distinguished Chair in Health Policy at the University of Texas Health Science Center at San Antonio. His email address is scarano@uthscsa.edu.

visit us at www.bcms.org

31

BOOK REVIEW

‘I am Malala: The Girl Who Stood Up for Education and Was Shot by the Taliban’ Written by Malala Yousafzai with Christina Lamb Reviewed by Rajam Ramamurthy, MD

“One year ago I left for school and never returned. I was shot by a Taliban bullet and was flown out of Pakistan unconscious. Some people say I will never return home, but I feel firmly in my heart that I will.” These are the heart-wrenching words of Malala Yousafzai, a 15-year-old who was shot point-blank in the head on Oct. 9, 2012, by the Taliban as she was returning home in her school bus. This was punishment for her taking a stand on education and being vocal.

The event was world news when it happened, and no one expected Malala to live, much less be cognitively intact to tell her story. The writing style, which I assume we should attribute to the co-author Christina Lamb, is very plain. This may actually be befitting, for a more flowery language may not bring out the simplicity, innocence and exuberance of a little girl in a small village in Swat Valley, Pakistan.

The narration is in first person by the protagonist, Malala. The protagonist takes action, makes judgments and expresses opinions, thereby not always allowing the audience to comprehend the other characters’ thoughts, feelings, or perceptions as much as the narrator’s own. We become aware of the events and characters of the story through the narrator’s views and knowledge.

As I was reading this book, I remembered another book in similar settings titled, “Three Cups of Tea” by Greg Morttenson. What drives a human to cause unimaginable harm to another human? How is this different from a soldier shooting and killing the enemy — another human as well? Often the emotional upheavals happen without the individual or group having any knowledge about what they are protesting about. In Malala’s book reference is made to “Satanic Verses” by Salman Rushdie, a parody of the prophet’s life. It was widely considered blasphemous and provoked so much protest in Pakistan that it was not even published.

32 San Antonio Medicine • August 2015

The part of the story that deals with Malala’s stay in Queen Elizabeth Hospital in the United Kingdom was very moving. The anxiety felt by the medical staff was palpable. The eyes of the world were on them. There is a sense of relief when Malala is out of danger of death, but my medical mind kept going back to the quality of survival. Had the outcome been different, if this book had not told the story as it did, would we know less about this very unique human being?

Malala received the Nobel Peace Prize along with Kailash Satyarthi in 2014. The two young people were honored for their struggle against suppression of children’s rights. In the poor countries of the world, 60 percent of the present population is under age 25. Showing great personal courage, Satyarthi, maintaining Gandhi’s tradition, has headed various forms of protests and demonstrations, all peaceful, focusing on the grave exploitation of children for financial gain.

Malala has fought for several years for the right of girls to be educated. It is unimaginable that in the 21st century there still is debate about educating girls, equal pay for women and the right of a woman to make medical decisions for herself. We all live in our own glass houses and can’t throw stones.

Malala addressed the United Nations on July 12, 2013, her 16th birthday. Her message: education for all children. She is a devout Muslim and prays for peace in every home.

Form your own opinion, for feelings are at a boiling point on both sides of the equation. The saga goes on about these irrelevant issues while thousands of children still remain without access to education.

Rajam Ramamurthy, MD, is professor emeritus in the UTHSCSA department of pediatrics, division of neonatology, and a past president of BCMS.

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Please support our sponsors with your patronage; our sponsors support us.

ACCOUNTING FIRMS Padgett Stratemann & Co., LLP (HH Silver Sponsor) Padgett Stratemann is one of Texas’ largest, locally owned CPA firms, providing sophisticated accounting, audit, tax and business consulting services.

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BANKING

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Lewis Thorne 210-220-6513 lthorne@frostbank.com www.frostbank.com “Frost@Work provides your employees with free personalized banking services.”

IBC Bank (HHH Gold Sponsor) IBC Bank is a $12.4 billion multibank financial company, with over 212 facilities and more than 325 ATMs serving 90 communities in Texas and Oklahoma. IBC BankSan Antonio has been serving the Alamo City community since 1986 and has a retail branch network of 30 locations throughout the area.

Markham Benn 210-518-2500, ext. 26921 MarkhamBenn@ibc.com www.ibc.com “Leader in commercial lending.”

Ozona Bank (HHH Gold Sponsor) Ozona National Bank is a full-service commercial bank specializing in commercial real estate, construction (owner and non-owner occupied), business lines of credit and equipment loans.

Lydia Gonzales 210-319-3501 lydiag@ozonabank.com www.ozonabank.com

The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians.

Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community.

Brandi Vitier 210-807-5581 brandi.vitier@ thebankofsa.com www.thebankofsa.com

Baptist Credit Union (HH Silver Sponsor) Baptist Credit Union’s mission is to meet our members’ needs by providing extraordinary service, quality financial products and personal financial education.

Sarah Chatham 210-525-0100, ext. 201 memberservices@baptistcu.org www.baptistcu.org “We commend your dedication to the health and well-being of our community.”

Cadence Bank (HH Silver Sponsor) Cadence Bank is a full-service financial institution serving commercial, consumer, treasury and wealth management clients in Texas and the Southeast.

Margarita Ortiz 210-764-5500 maggie.ortiz@cadencebank.com Steve Edlund 210-764-5573 steve.edlund@cadencebank.com http://cadencebank.com “Explore Cadence Bank’s innovative financing options and treasury management solutions.”

Firstmark Credit Union (HH Silver Sponsor) Address your office needs: Upgrading your equipment or technology • Expanding your office space • We offer loans to meet your business or personal needs.

Competitive rates, favorable terms and local decisions.

Gregg Thorne SVP Lending 210-308-7819 greggt@firstmarkcu.org www.firstmarkcu.org Generations Federal Credit Union (HH Silver Sponsor) Generations provides a wide array of innovative products including loan, deposit and investment solutions for personal and commercial banking needs.

Yvonne "Bonnie" M. Aguilar 210-229-1800 bonnie.aguilar@ mygenfcu.org www.mygenfcu.org “For this generation and the next.”

Continued on page 34 visit us at www.bcms.org

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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Continued from page 33 RBFCU (HH Silver Sponsor) 210-945-3800 businesslending@rbfcu.org www.rbfcu.org St. Joseph's Credit Union (HH Silver Sponsor) A credit union providing savings, checking, IRA, club and CD accounts, plus auto, signature, lines of credit, MasterCard and real estate loans.

Armando Rodriguez 210-225-6126 arodriguez@sjcusatx.net www.sjcusatx.com “Better rates on auto loans, signature loans and Platinum MasterCard.”

BIOMEDICAL WASTE DISPOSAL

BioMedical Waste Solutions, LLC (HHH Gold Sponsor) Save costs on your medical waste disposal! BioMedical Waste Solutions provides a compliant, reliable and low-cost service.

Wes Sonnier 1-877-974-1300 Wes@BioMed-Disposal.com Joe Loyacano 1-877-974-1300 Joe@BioMed-Disposal.com www.BioMedicalWasteSolutions.com “BCMS members save 10 percent off or one free month! Request a free quote in 10 seconds at www.BioMedicalWasteSolutions.com.”

CONTRACTORS/BUILDERS/ COMMERCIAL

Huffman Developments (HHH Gold Sponsor) Premier medical and professional office condominium developer.

Our model allows you to own your own office space as opposed to leasing.

Steve Huffman 210-979-2500 Shawn Huffman 210-979-2500 www.huffmandev.com

RC Page Construction, LLC (HHH Gold Sponsor)

34 San Antonio Medicine • August 2015

Clay Page 210-375-9150 clay@rcpageconstruction.com

CUSTOM HOME BUILDERS

Diamante Custom Homes (HHH Gold Sponsor) Diamante Custom Homes: Experience your new custom homebuilding process through San Antonio’s leading design-build firm. Over two decades of streamlining the balance between your budget and your dreams. The name you know from the builders you trust!

Keith Norman 210-341-6430 knorman@diamantehomes.com www.diamantehomes.com “Special promotions for all BCMS members – call us today!”

EDUCATION Alpha Bilingual Preschool (H Bronze Sponsor) Our mission is to provide young children with an integral early education in a Spanish-immersion environment.

Tania Lopez de Pelsmaeker 210-348-8523 tldp@hotmail.com “Give your children the gift of speaking a second language.”

ELECTRONIC DOCUMENTATION AND TRANSCRIPTION SERVICES

Med MT, Inc. (HHH Gold Sponsor) Narrative transcription is physicians’ preferred way to create patient documents and populate electronic medical records.

Ray Branson 512-331-4669 branson@medmt.com www.medmt.com “The Med MT solution allows physicians to keep practicing just the way they like.”

ELECTRONIC MEDICAL RECORDS

Greenway Health (HHH Gold Sponsor) Greenway Health offers a fully integrated electronic health record (EHR/EMR), practice management (PM) and interoperability solution that helps healthcare providers improve care coordination, quality and satisfaction while functioning at their highest level of efficiency.

Stacy Berry 830-832-0949 Stacy.berry@greenwayhealth.com www.greenwayhealth.com

FINANCIAL SERVICES

Northwestern Mutual Wealth Management (HHHH Platinum Sponsor) Comprehensive financial planning, insurance and investment planning, estate planning and trust services.

Eric Kala, CFP, CLU, ChFC Wealth Management Advisor 210-446-5752 eric.kala@nm.com www.erickala.com

Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life.

Jeffrey Allison 210-268-1530 jallison@ aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”

Frost Leasing (HHH Gold Sponsor) As one of the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment and

insurance services to individuals and businesses.

Laura Elrod Eckhardt 210-220-4135 laura.eckhardt@frostbank.com www.frostbank.com “Commercial leasing for a doctor’s business equipment and vehicle.”

Bob Davidson New York Life (HH Silver Sponsor) Dedicated agent at New York Life helping physicians and medical professionals achieve their financial dreams.

Bob Davidson 210-321 1445 rdavidson02@ft.newyorklife.com www.linkedin.com/in/bobdavidsonnyl “Taking care of those who take care of us.”

Platinum Wealth Solutions of Texas, LLC (HH Silver Sponsor) Comprehensive financial planning firm which assists medical professionals to protect their income, their wealth, their practice and legacy.

Tom Valenti 210-998-5023 tvalenti@jhnetwork.com Eric Gonzalez 210-998-5032 ericgonzalez@jhnetwork.com www.platinumwealthsolutionsoftexas.com “Understanding the uniqueness in the financial life as a physician.”

Retirement Solutions (HH Silver Sponsor) Committed to providing comprehensive, reliable consultation to help you navigate the complex world of retirement planning.

Robert C. Cadena 210-342-2900 robert@retirementsolutions.ws www.retirementsolutions.ws

HIPAA COMPLIANCE SERVICES Cyber Risk Associates (HH Silver Sponsor) Cyber Risk Associates provides HIPAA compliance services designed for small practices, offering enterprise-quality privacy and security programs, customized to your needs.

David Schulz 210-281-8151 DAS@CyberRiskAssociates.com www.CyberRiskAssociates.com

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY HIPAA/MANAGED IT/ VOIP/SECURITY

Hill Country Tech Guys (HHH Gold Sponsor) Provides complete technology services to many different industries, specializing in the needs of the financial and medical industries. Since 2006, our goal has always been to deliver relationship-based technology services that exceed expectations.

Bill Gower 877-315-0788 Bill@hctechguys.com http://hctechguys.com/ “IT problems? Yeah… we can fix that!”

HOSPITALS/ HEALTHCARE SERVICES

First Choice Emergency Room (HHH Gold Sponsor) The nation's oldest and largest network of independent freestanding emergency rooms. Patients seen almost immediately; board-certified physicians and emergency-trained registered nurses. In-house CT scanner, ultrasound, digital X-ray and COLA/CIA accredited on-site lab to handle emergencies 24/7/365.

Hardy Oak Boulevard 24-hour 210-451-8340 Nacogdoches Road.

24-hour 210-447-7560 Tezel Road 24-hour 210-437-1180 www.fcer.com “Check-in online — free, easy, fast!”

Warm Springs •Medical Center •Thousand Oaks •Westover Hills (HHH Gold Sponsor) Our mission is to serve people with disabilities by providing compassionate, expert care during the rehabilitation process, and support recovery through education and research.

Central referral line 210-592-5350 “Joint Commission COE.”

Elite Care Emergency (HH Silver Sponsor) 24/7 full-service, no-wait, freestanding ER with board-certified physicians and RNs offering Elite Care advantage for patients.

Marketing Liaison Dlorah Martin 509-592-7998 dmartin@elitecareemergency.com Marketing liaison Kylyn Stark 210-978-4110 kstark@elitecareemergency.com www.elitecareemergency.com “When seconds count, Elite Care can make ALL the difference.”

Methodist Healthcare System (HH Silver Sponsor) Palmira Arellano 210-575-0172 palmira.arellano@mhshealth.com http://sahealth.com/ Seasons Hospice and Palliative Care (HH Silver Sponsor) Seasons Hospice and Palliative Care engenders hope in the lives of its patients and their family members. We are here for you.

Deb Houser-Bruchmiller Executive Director 210-471-2300 dhouser@seasons.org www.seasons.org Select Rehabilitation of San Antonio (HH Silver Sponsor) We provide specialized rehabilitation programs and services for individuals with medical, physical and functional challenges.

Miranda Peck 210-482-3000 mipeck@selectmedical.com http://sanantonio-rehab.com “The highest degree of excellence in medical rehabilitation.”

HUMAN RESOURCES

Employer Flexible (HHH Gold Sponsor) Employer Flexible doesn’t simply lessen the burden of HR administration. We provide HR solutions to help you sleep at night and get everyone in the practice on the same page.

John Seybold 210-447-6518 jseybold@employerflexible.com www.employerflexible.com “BCMS members get a free HR assessment valued at $2,500.”

INSURANCE

Blue Cross Blue Shield of Texas (HHH Gold Sponsor) Edna Pérez-Vega 210-558-5162 Edna_Perez-Vega@bcbstx.com www.BCBSTX.com

Frost Insurance (HHH Gold Sponsor) As one of the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment and insurance services to individuals and businesses.

Bob Farish 210-220-6412 bob.farish@frostbank.com www.frostbank.com “Business and personal insurance tailored to meet your unique needs.”

Humana (HHH Gold Sponsor) Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care.

Donnie Hromadka 512-338-6151 dhromadka@humana.com www.humana.com

Texas Medical Association Insurance Trust (HHH Gold Sponsor) Created and endorsed by the Texas Medical Association (TMA), the TMA Insurance Trust helps physicians, their families and their employees get the insurance coverage they need.

Wendell England 512-370-1746 wengland@tmait.org James Prescott 512-370-1776 jprescott@tmait.org John Isgitt 512-370-1776 www.tmait.org “We offer BCMS members a free insurance portfolio review.”

Catto & Catto (HH Silver Sponsor) Providing insurance, employee benefits and risk-management products and services to thousands of businesses and individuals in Texas and the United States.

Crystal Metzger James L. Hayne Jr. 210-222-2161 www.catto.com Joel Gonzales Agency Nationwide (HH Silver Sponsor) Joel Gonzales 210-275-3595 www.nationwide.com/jgonzales

INSURANCE/MEDICAL MALPRACTICE

Texas Medical Liability Trust (HHHH Platinum Sponsor) Texas Medical Liability Trust is a physician-owned healthcare liability claim trust providing malpractice insurance products to the physicians of Texas. Currently, we protect more than 17,000 physicians in all specialties who practice in all areas of the state.

TMLT is a recommended partner of the Bexar County Medical Society and is endorsed by the Texas Medical Association, the Texas Academy of Family Physicians, and the Dallas, Harris, Tarrant and Travis counties medical societies.

Patty Spann 512-425-5932 patty-spann@tmlt.org www.tmlt.org “Recommended partner of the Bexar County Medical Society.”

MedPro Group (HHH Gold Sponsor) Medical Protective is the nation's oldest and only AAA-rated provider of healthcare malpractice insurance.

Thomas Mohler 512-213-7714 thomas.mohler@medpro.com www.medpro.com

The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and

Continued on page 36 visit us at www.bcms.org

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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Continued from page 35 banking products for physician groups and individual physicians.

Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community.

Katy Brooks, CIC 210-807-5593 katy.brooks @bosainsurance.com www.thebankofsa.com “Serving the medical community.”

NORCAL Mutual Insurance Co. (HH Silver Sponsor) Since 1975, NORCAL Mutual has offered medical professional liability coverage to physicians and is “A” (Excellent) rated by A.M. Best.

Patrick Flanagan 844-4-NORCAL pflanagan@norcal-group.com www.norcalmutual.com ProAssurance (HH Silver Sponsor) ProAssurance helps you control your professional risk and navigate today’s changing medical environment with greater ease — that’s only fair.

Keith Askew 512-314-4368 Kaskew@proassurance.com Mark Keeney 512-314-4347, ext. 7347 Mkeeney@api-proassurance.com www.proassurance.com “A.M. Best-rated A+ (Superior), ProAssurance treats you fairly.”

The Doctors Company Medical Malpractice Insurer (HH Silver Sponsor) We relentlessly defend, protect and reward the practice of good medicine. As the patient safety industry leader, we proudly offer a comprehensive selection of CME opportunity and risk-mitigation resources.

Kirsten Baze 512-275-1874 KBaze@thedoctors.com www.TheDoctors.com

INTERNET/ TELECOMMUNICATIONS

Time Warner Cable Business Class (HHH Gold Sponsor) When you partner with Time Warner Cable Business Class, you get the advantage of enterpriseclass technology and

36 San Antonio Medicine • August 2015

communications that are highly reliable, flexible and priced specifically for the medical community.

Rick Garza 210-582-9597 Rick.garza@twcable.com “Time Warner Cable Business Class offers custom pricing for BCMS Members.”

IT SUPPORT/VOIP/ CLOUD SERVICES

ICS (HHH Gold Sponsor) ICS® is a Texas-based provider of business technology integration solutions, including managed IT support, business telephones, VoIP communications, video conferencing systems, surveillance cameras, and voice/data cabling.

Family owned since 1981.

Daniel Simons 210-581-9020 daniel.simons@ics-com.net Robert Foehrkolb 210-225-5427 rfoehrkolb@ics-com.net www.ics-com.net “Providing IT, voice and video solutions for business.”

LABORATORY SERVICES

PGX TESTING (HHH Gold Sponsor) PGX Testing is a multi-faceted diagnostics company currently offering pharmacogenomics, urine toxicology, women's health testing, cancer screening, and wellness testing to the medical profession.

Charlie Rodkey Sr. charlie@pgxt.com 210-218-8610 Ryan Rodkey ryan@pgxt.com 210-323-7717 Ron Inselmann ron@pgxt.com 210-382-7761 www.PGXT.com Clinical Pathology Laboratories (HH Silver Sponsor) Mitchell Kern 210-229-2513 mkern@cpllabs.com www.cpllabs.com

MARKETING SERVICES Digital Marketing Sapiens (HH Silver Sponsor) Healthcare marketing professionals with proven experience and solid understanding of compliance issues. We deliver innovative marketing solutions that drive results.

Irma Woodruff 210-410-1214 irma@dmsapiens.com Ajay Tejwani 210- 913-9233 ajay@dmsapiens.com www.DMSapiens.com Know Your Doctor SA (HH Silver Sponsor) Increase your practice’s unique marketing/communications program. Connect with SA community through video, advertising, PR and medical opinion e-news.

Limited to 300 physicians.

Lorraine Williams 210-884-7505 LWilliams@KnowYourDoctorSA.com www.knowyourdoctorsa.com

MEDICAL BILLING AND COLLECTIONS SERVICES

DataMED (HHH Gold Sponsor) Providing your practice with the latest compliance solutions, concentrating on healthcare regulations affecting medical billing and coding changes, allowing you and your staff to continue delivering excellent patient care.

Betty Aguilar 210-892-2331 baguilar@datastreamllc.net www.datamedbpo.com “BCMS members receive a discounted rate for our billing services.”

Commercial & Medical Credit Services (HH Silver Sponsor) A bonded and fully insured San Antonio-based collection agency.

Henry Miranda 210-340-9515 hcmiranda@sbcglobal.net www.cmcs-sa.com “Make us the solution for your account receivables.”

MEDICAL SUPPLIES AND EQUIPMENT

Henry Schein Medical (HHHH Platinum Sponsor) From alcohol pads and bandages to EKGs and ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines and pharmaceuticals serving office-based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere.

Tom Rosol 210-413-8079 tom.rosol@henryschein.com www.henryschein.com “BCMS members receive GPO discounts of 15 percent to 50 percent.”

McKesson Medical-Surgical (H Bronze Sponsor) McKesson is a leading distributor of medical supplies and equipment.

Karan Cook 210-573-2117 karan.cook@mckesson.com

MEDICAL TRAINING/ HANDS ON

LINRON® Bioskills Training Institute (HHH Gold Sponsor) LINRON® is dedicated to providing hands-on medical training to healthcare professionals who want to improve their clinical skills and offer their patients the latest in treatment modalities while using state-of-the-art medical equipment and technology.

Yolanda S. Garza, RN 210-572-2434 yolanda.garza@linrontraining.com www.linrontraining.com

MENTAL HEALTH EDUCATION AND CONSULTING

The Ecumenical Center (HHH Gold Sponsor) The Ecumenical Center provides faith-based counseling and education for healing, growth and wellness. The center is a catalyst, bringing together community

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY leaders in research, education, ethics, medical and mental health professions.

Mary Beth Fisk 210-616-0885, ext. 215 mbfisk@ecrh.org www.ecrh.org

MERCHANT PAYMENT SYSTEMS/CARD PROCESSING Heartland Payment Systems (HH Silver Sponsor) Heartland Payments is a true cost payment processor exclusively endorsed by over 250 business associations.

Tanner Wollard 979-219-9636 tanner.wollard@e-hps.com www.heartlandpaymentsystems.com “Lowered cost for American Express; next day funding.”

OFFICE EQUIPMENT/ TECHNOLOGIES

Dahill (HHH Gold Sponsor) Dahill offers comprehensive document workflow solutions to help healthcare providers apply, manage and use technology that simplifies caregiver workloads. The results: Improved access to patient data, tighter regulatory compliance, operational efficiencies, reduced administrative costs and better health outcomes.

Ronel Uys 210-805-8200, ext. 10105 ruys@dahill.com www.dahill.com

ORGANIZATIONS CRIT USA (HH Silver Sponsor) Ricardo Guzman Hefferan 210-257-6260 guzman@teletonusa.org www.teletonusa.org

REAL ESTATE/ COMMERCIAL Cano and Company Commercial Real Estate (HH Silver Sponsor) Experienced and respected commercial real estate representation. We specialize in office leasing, property acquisition, and commercial real estate investment.

Dennis Cano, Agent 210-731-6613 Dennis@canoandcompany.com “Effective commercial real estate solutions for your practice and investments.”

STAFFING SERVICES

Endura Advisory Group (HH Silver Sponsor) Endura Advisory Group specializes in representing physicians and clients in the purchase, lease, sale, management or sublease of commercial real estate.

Vicki Cade, CCIM 210-366-2222 Mobile 210-827-7640 vcade@endurasa.com Teresa Corbin 210-366-2222 tcorbin@endurasa.com www.endurasa.com

Favorite Healthcare Staffing (HHHH Platinum Sponsor) Serving the Texas healthcare community since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive range of staffing services to help members improve cost control, increase efficiency and protect their revenue cycle.

Brody Whitley Branch Director 210-301-4362 bwhitley@ favoritestaffing.com www.favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”

REAL ESTATE/ RESIDENTIAL Kuper Sotheby's International Realty (HH Silver Sponsor) My hometown roots are based in Fredericksburg while my home away from home is San Antonio. Local knowledge — exceptional results.

Joe Salinas III 830-456-2233 Joe.Salinas@SothebysRealty.com JoeSalinas.com “Embrace your new life ...

I'll help you become a connoisseur.”

SENIOR LIVING Legacy at Forest Ridge (HH Silver Sponsor) Legacy at Forest Ridge provides residents with toptier care while maintaining their privacy and independence, in a luxurious resort-quality environment.

Shane Brown Executive Director 210-305-5713 hello@ legacyatforestridge.com www.LegacyAtForestRidge.com “Assisted living like you’ve never seen before.”

TRAVEL CONSULTANTS Alamo Travel Group (HH Silver Sponsor) Locally owned travel agency for over 30 years, offering personalized travel services for your next family vacation, business travel needs or group travel. American Express Travel Network representative.

Mary Jo Salas 210-593-5500 msalas@alamotravel.com www.amazingjourneysbyalamo.com “See what a difference we can make for you!”

As of July 14, 2015 For more information, call 210-301-4366, or email August.Trevino@ bcms.org, or visit www.bcms.org.

visit us at www.bcms.org

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THANK YOU

to the large group practices with 100% MEMBERSHIP in BCMS and TMA ABCD Pediatrics, PA

Renal Associates of San Antonio, PA

Clinical Pathology Associates

San Antonio Gastroenterology Associates, PA

Dermatology Associates of San Antonio, PA

San Antonio Kidney Disease Center

Diabetes & Glandular Disease Clinic, PA

San Antonio Pediatric Surgery Associates, PA

ENT Clinics of San Antonio, PA

Sound Physicians

Gastroenterology Consultants of San Antonio

South Alamo Medical Group

General Surgical Associates

South Texas Radiology Group, PA

Greater San Antonio Emergency Physicians, PA

Tejas Anesthesia, PA

Institute for Women's Health

Texas Partners in Acute Care

Lone Star OB-GYN Associates, PA

The San Antonio Orthopaedic Group

M & S Radiology Associates, PA

Urology San Antonio, PA

MacGregor Medical Center San Antonio

Village Oaks Pathology Services/ Precision Pathology

MEDNAX Peripheral Vascular Associates, PA Contact BCMS today to join the 100% Membership Program!

38 San Antonio Medicine • August 2015

WellMed Medical Management Inc. *100% member practice participation as of July 15, 2015.

North Park Mazda 9333 San Pedro Ave. Ancira Chrysler 10807 IH-10 West Gunn Acura 11911 IH-10 West

* Gunn Infiniti 12150 IH-10 West

Cavender Toyota 5730 NW Loop 410

Ingram Park Auto Center 7000 NW Loop 410 Mercedes-Benz of Boerne 31445 IH-10 W, Boerne Ancira Dodge 10807 IH-10 West

Cavender Audi 15447 IH-10 West

Cavender Buick 17811 San Pedro Ave. (281 N @ Loop 1604)

Ingram Park Auto Center 7000 NW Loop 410

Northside Ford 12300 San Pedro Ave.

Ancira Jeep 10807 IH-10 West

Mercedes-Benz of San Antonio 9600 San Pedro Ave.

Ingram Park Auto Center 7000 NW Loop 410

* North Park Lexus 611 Lockhill Selma

Ancira Nissan 10835 IH-10 West

North Park Toyota 10703 Southwest Loop 410

* Ancira Volkswagen 5125 Bandera Rd. North Park VW at Dominion 21315 IH-10 West

Ingram Park Nissan 7000 NW Loop 410

North Park Lexus Dominion 21531 IH-10 West Frontage Road Cavender GMC 17811 San Pedro Ave.

Batchelor Cadillac 11001 IH-10 at Huebner

Gunn GMC 16440 IH-35 North

Tom Benson Chevrolet 9400 San Pedro Ave.

* Fernandez Honda 8015 IH-35 South

Gunn Chevrolet 12602 IH-35 North

Gunn Honda 14610 IH-10 West (@ Loop 1604)

Ancira Ram 10807 IH-10 West * North Park Lincoln/ Mercury 9207 San Pedro Ave.

Ingram Park Auto Center 7000 NW Loop 410

North Park Subaru 9807 San Pedro Ave. Ingram Park Auto Center 7000 NW Loop 410

North Park Subaru at Dominion 21415 IH-10 West

visit us at www.bcms.org

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AUTO REVIEW

Porsche Macan:

Compact SUV moves crisply, offers intuitive user interface

By Steve Schutz, MD

After Volkswagen bought Porsche three years ago, I predicted that executives in charge of those myriad VW-owned brands — Audi, Bentley, Lamborghini, et al — would create a new Porsche based on the Audi Q5 platform. While my automotive clairvoyance has been spotty over the years, this prediction proved correct, and now we have the impressive Porsche Macan, just introduced last year, to enjoy.

I’ve told this story before, but it bears repeating as we examine the Macan. Twelve

40 San Antonio Medicine • August 2015

years ago, Porsche endured derision and contempt from many enthusiasts, including me, when they launched their first SUV, the Cayenne. I applauded Jaguar, who responded to the idea of their own SUV by stating publicly that they would sell only cars, and I quietly hoped the Cayenne would die. But sales figures say that Porsche was right, and Jaguar and I were wrong. While in 2000 Porsche sold 22,410 cars in the United States compared with 43,728 Jaguars, in 2014 the story was reversed, with Porsche selling a remark-

able 47,007 cars and SUVs compared with Jaguar’s 15,773 cars. Given that reality, it’s no surprise that Jaguar just announced the development of its first SUV. It would appear that going where your customers want you to go is a good strategy.

HANDSOME AS ROB LOWE On to the Macan, which, while being a compact SUV like the Q5, looks a lot like its big brother, the Cayenne. In fact, the profiles are so similar you’d be forgiven for not being

AUTO REVIEW able to tell them apart despite the Macan’s more angled rear hatch and 911-ish tail lights. Both vehicles are as comfortably handsome as Rob Lowe, which helps explain their popularity but also raises the obvious question, where were the Porsche designers with good taste when the design of the Panamera sedan was approved?

Anyway, the now-familiar Porsche interior with its raised center console, elegant switch ware, and intuitive user interface is easy on the eyes and a very pleasant place in which to spend time. Despite the contemporary look, though, consistent Porsche touchstones like a large tachometer located in the center of the gauge cluster and the ignition switch placed to the left of the steering wheel remain. The materials in all Porsches are first rate, and that was indeed the case in my test car, but I was discouraged to find that the small door covering the cigarette lighter broke during my time with the car.

BOTH MODELS HAVE TURBOS Customers who pay a premium for the Porsche driving experience won’t care about trifles like a cigarette lighter door, and I experienced no disappointment in that department. Even in standard driving mode, the Macan moves much more crisply than the Q5, never mind the more pedestrian Lexus RX or Cadillac SRX. Push either the Sport or Sport Plus buttons though, and things really get interesting, with more rapid gear changes, quicker throttle response, and firmer suspension settings. There’s also a noticeable and pleasing blat-blat-blat from the exhaust when you decelerate that’s absent in standard mode. Yet while those more athletic settings do indeed move the Macan faster, they’re not too jarring, so you don’t get beat up when you select them.

Currently there are just two Macan models, the S and the Turbo. The top-level Turbo version like my test car includes a 400 HP twin-turbo 3.6-liter V6, while the S comes with a similar twin-turbo V6 which measures 3.0 liters and produces 340 HP. It’s a little surreal to behold a Porsche S

and Turbo which both have turbos, but we’d better get used to that because it’s the future of Porsche. Next year it’s expected that all Porsche engines will be turbocharged, including those in every 911.

A base Macan slotted below the Macan S is likely to appear later this year with a turbocharged four-cylinder engine, while a Macan diesel with a turbo 3.0-liter V6 also will arrive in 2015.

As always with any Porsche, options and option packages are numerous and can increase the cost of your car significantly. The Macan Turbo starts at just over $72,000, but my loaded tester carried a sobering $104,000 price tag. In an effort to rein in natural but unneeded exuberance, I’d suggest that any potential buyer spend time on the online Porsche configurator before talking to your local dealer. Or just call Phil Hornbeak (see below) who will happily and helpfully walk you through the process.

The Macan is so good to drive I’ll bet Porsche wouldn’t have gotten nearly as much grief as it did for the Cayenne if it had introduced the smaller SUV first. Whatever, it’s here now, and it is indeed a delight to experience. In fact, the only problem prospective customers are likely to have for a while is a long wait. Macans are proving to be so popular that they’re hard to find at dealerships.

Steve Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the U.S. Air Force. He has been writing auto reviews for San Antonio Medicine since 1995.

For more information on the BCMS Auto Program, call Phil Hornbeak at 3014367 or visit www.bcms.org.

visit us at www.bcms.org

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HELP WANTED Bexar County Medical Society members for BCMS Communications/ Publications Committee. Should have little or no experience, be willing to brainstorm, eat supper at the BCMS office once each month, and participate in free-wheeling, stimulating discussions to produce the magazine you’re reading at this moment.

For information, call Susan Merkner at

210-582-6399.

42 San Antonio Medicine • August 2015